Running: Preventing Overuse Injuries

It is common for runners to overdo it. Each year, up to 70% of runners develop injuries. They most often occur because of a training error. You may run too far, too fast, or too soon after an injury. As a runner, it is important to take care of your body. There are things you can do to help prevent overuse injuries from running.

Path to safety

You can lower your risk of running injuries by doing the following:

Start slow if you are new to running. Alternate walking and running to ease into it.

Do not increase your running mileage by more than 10% per week.

Do not run more than 45 miles per week. There is little proof that running this much improves your performance. In fact, it can increase your risk of an overuse injury.

Do not run on slanted or uneven surfaces. The best running surface is soft, flat ground.

Do not “run through pain.” Pain is a sign that something is wrong and you shouldn’t ignore it.

If you have pain when you run, rest for 2 to 3 days and use ice. See your doctor if the pain continues for 1 week.

Alternate hard running or training days with easy days.

Change your running shoes every 500 miles. At this distance, shoes can no longer absorb the shock of running.

Stretching and strengthening exercises are important for prevention. Ideally, you should stretch on days you run and rest. This also can be part of an injury recovery plan. You should do each stretch until you feel tension but not pain. Never bounce with an exercise.

Be consistent with your exercises. Do 3 sets of each exercise with 10 repetitions in each set. Make sure you exercise both legs equally. Try not to favor a leg that is weaker or injured. You can add ankle weights as the exercises become easier for you. Below are example exercises that you can follow.

Stretching exercises

Hamstring stretch

Sit with your right leg straight in front of you and your left leg bent to the side. With your back straight and your head up, lean forward at your waist. Try to touch your toes. You should feel the stretch along the underside of your thigh. Hold the stretch for 10 to 15 seconds. Repeat and switch legs. This exercise may be helpful for people who have:

Patellar tendinitis: inflammation of the tendon that connects the knee and tibia.

Hamstring strain: overstretching or tearing of the muscles on the back of the thigh.

Iliotibial (IT) band stretch

Sit with your right leg straight in front of you and your left leg crossed over it. Twist at your waist to the left and pull your left leg across your chest. You should feel the stretch along the side of your hip and IT band. Hold the stretch for 10 to 15 seconds. Repeat and switch legs. This exercise will be helpful for IT band injuries.

Groin stretch

Sit with your legs bent and knees open to the side. Hold your feet together. Keep your back straight, head up, and elbows on the inside of your knees. Push down on the inside of your knees with your elbows. You should feel the stretch along the inside of your thighs. You can lean forward over your legs to increase the stretch. Hold the stretch for 10 to 15 seconds. Repeat. This exercise may be helpful for adductor strains, overstretching of the groin muscles.

Quadriceps stretch

Stand straight on both legs. Bend your right leg behind you and take hold of your foot. Pull your right heel toward your buttocks. You should feel the stretch in the front of your thigh. Hold the stretch for 10 to 15 seconds. Repeat and switch legs. This exercise may be helpful for PFPS, patellar tendinitis, and IT band injuries.

Calf stretch

Stand with your hands against a wall and your right leg behind your left leg. Keep your right leg straight, heel flat on the floor, and foot pointed straight ahead. Bend your left leg, making sure your knees are over your toes, and lean forward. You should feel the stretch in the middle of your calf. Hold the stretch for 10 to 15 seconds. Repeat and switch legs. This exercise may be helpful for:

Achilles tendinitis: inflammation of the Achilles tendon, the large tendon at the back of the ankle.

Calcaneal apophysitis: inflammation where the Achilles tendon attaches to the heel. This is more common in children.

Plantar fascia stretch

Stand straight with your hands against a wall and your right leg slightly behind your other leg. Keep your heels flat on the floor. Bend both knees, making sure your knees are over your toes. You should feel the stretch in your heel, arch, and lower part of your leg. Hold the stretch for 10 to 15 seconds. Repeat and switch legs. This exercise may be helpful for plantar fasciitis, calcaneal apophysitis, and Achilles tendinitis.

Strengthening exercises

Straight leg lift

Lie down on your back, then support your upper body on your elbows. Engage the top of the thigh muscles of your right leg. Raise your right leg off the floor in 4 counts, hold for 2 counts, and lower it in 4 counts. Relax your leg and thigh muscles. Repeat and switch legs. This exercise may be helpful for PFPS and patellar tendinitis.

Side leg lift

Lie down on your right side. Engage the thigh muscles of your left leg. Raise your left leg off the floor in 4 counts, hold for 2 counts, and lower it in 4 counts. Relax your leg and thigh muscles. Repeat and switch legs. This exercise may be helpful for IT band injuries.

Inner thigh lift

Lie down on your right side with your left leg crossed over the knee of your right leg. Engage the inner thigh muscle of your right leg. Raise your right leg about 6 to 8 inches off the floor. Hold for 2 seconds and then lower it back down. Relax your leg and thigh muscles. Repeat and switch legs. This exercise may be helpful for adductor strains.

Lying leg lift

Lie down on your stomach. Engage the thigh muscles of your right leg. Raise your right leg off the floor in 4 counts, hold for 2 counts, and lower in 4 counts. Relax your leg and thigh muscles. Repeat and switch legs. This exercise may be helpful for hamstring strains.

Standing wall slide

Stand with your back against the wall. Your feet should be slightly apart and 6 to 8 inches away from the wall. Bend your legs and lower your back and hips about one-third of the way down the wall. Make sure your knees are over your toes. Hold the position for about 10 seconds or until you feel your thigh muscles become tired. Straighten back up to standing. Repeat. This exercise may be helpful for PFPS and patellar tendinitis.

Lateral step-ups

Start with both legs on a stair or platform that is 4 to 6 inches high. Lower your right leg, putting your heel on the floor. Straighten the knee of your left leg, allowing the foot of your right leg to lift slightly off the floor. Repeat and switch legs. This exercise may be helpful for PFPS and patellar tendinitis.

Walking lunge

Stand straight on both legs. Step your right leg forward about a foot and keep your heels on the ground. Bend both legs, making sure your knees are in line with your toes. Hold for 2 seconds. Straighten your legs. Repeat and switch legs. This exercise may be helpful for PFPS and patellar tendinitis.

Things to consider

Some doctors suggest wearing orthotics or compression socks or sleeves. These can help prevent running injuries. Orthotics are shoe inserts that can correct bad alignment between your foot and lower leg. You might need orthotics if your feet turn in, a problem called pronation. If you have bad alignment but don’t have pain or injuries from running, you probably don’t need orthotics. Compression socks and sleeves help increase circulation. People who run a lot and have poor blood flow may need to wear these.

Questions to ask your doctor

Should I do stretching and strengthening exercises before and/or after I run?

How do I know if an overuse running injury is treatable or not?

If I have an overuse injury, how long do I need to rest for?

How do I know if I need to wear orthotics or compression socks or sleeves?